We investigated the association between the content of the information exchanged between clients ... more We investigated the association between the content of the information exchanged between clients and therapists during mental health intake and the quality of the therapeutic alliance. Thirty-eight therapists and 107 clients from four mental health clinics in Israel participated in the study. The content of information discussed was coded directly from the recorded intakes by blinded raters. Clients and therapists completed the Working Alliance Inventory immediately following the intake. Therapists spent the majority of intake time in collecting information about their clients' diagnostic symptoms and personal history and sociocultural background. Due to the high negative correlation between these factors, r(107) = -.68, p < .001, we created a measure of delta score with higher scores reflecting more discussion of personal history and sociocultural background and less discussion of diagnostic symptoms. We computed three-level hierarchical linear model analysis, with intakes n...
proposes the implementation of primary prevention strategies to reduce the mental health burden o... more proposes the implementation of primary prevention strategies to reduce the mental health burden of disease. The extent to which Israeli academic programs and published research adhere to the principles spelled out by the CMHAP is unknown.
Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and prac... more Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and practice. This study compared adaptive functioning validity ratings from Structured Clinical Interviews (SCIDs, symptom-focused structured diagnostic interviews), and Clinical Diagnostic Interviews (CDIs, systematic diagnostic interviews modeling naturalistic clinical interactions focusing on relational narratives). Two hundred forty-five patients (interviewed by two independent interviewers) and their interviewers completed the Clinical Data Form which assesses adaptive functioning and clinical information. Both interviews converged strongly with patient-reports, with no significant differences in validity of the interviews in measuring global and specific domains of adaptive functioning variables. Findings suggest that CDIs provide adaptive functioning data comparable to SCIDs (often considered &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; for assessment but difficult to use in practice) and have important implications for bridging the research-practice gap. By incorporating clinicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; everyday methods, CDIs yield information that is psychometrically sound for empirical investigation, diagnostically practical, and clinically meaningful and valid.
The Israel journal of psychiatry and related sciences, 2014
Community-based studies have documented gender differences in mental health problems and service ... more Community-based studies have documented gender differences in mental health problems and service utilization. This mixed methods study explored gender differences in severity of emotional distress, referral paths, presenting problems and care expectations among service users upon accessing outpatient psychiatric care. Consecutive service users (N=284, 64% women) who presented for a new or repeated episode of care in adult outpatient clinics completed questionnaires on a measure of emotional distress, treatment history and referral path. These variables were quantitatively analyzed. Also, users completed two open-ended questionnaires on reasons for seeking care and expectations from the services. These variables were qualitatively analyzed using thematic analyses. No significant gender differences emerged on any of the variables examined among new and repeated users. The main reasons for seeking care were psychiatric symptoms as well as non-specific psychopathology. The most frequent...
Cultural diversity & ethnic minority psychology, Jan 4, 2014
Past research has documented the role acculturation plays in the process of adjustment to new cul... more Past research has documented the role acculturation plays in the process of adjustment to new cultures among migrants. Yet little attention has been paid thus far to the role of acculturation in the context of forced migration. In this study we examined the association between acculturation patterns and mental health symptoms among a convenience sample of Eritrean and Sudanese asylum seekers (n = 118) who accessed health services at the Physicians for Human Rights Open-Clinic in Israel. Participants completed measures on sociodemographic information as well as detention history, mental health symptoms, exposure to traumatic events, and acculturation pattern, in their native language upon accessing services. Consistent with our predictions, findings showed that acculturation predicted depressive symptoms among asylum seekers beyond the effect of history of detention and reports of experiences of traumatic events. Assimilated compared with integrated asylum seekers reported higher dep...
The Israel journal of psychiatry and related sciences, 2012
Mental health disparities are differences in health status, risks and care favoring members of ad... more Mental health disparities are differences in health status, risks and care favoring members of advantaged over disadvantaged social groups. the contrasting social identities of clinicians and service-users may account for potential disparities found in clinical encounters, reflected, for example, in the provision of substandard care. the imputed mechanisms, however, remain unknown. Drawing on social psychological research we delineate a model to assist in identifying those mechanisms. we review the literature on processes rooted in social categorization (outgroup bias) and in social power (impaired perspective taking, making automatic attributions) and suggest that the contrasting social identities of clinicians and service-users can partially account for why discordant, compared to concordant ethnic identities in clinical encounters may produce worse outcomes, measured by the quality of the working alliance and the accuracy of diagnostic decisions. we provide preliminary evidence f...
ABSTRACT The study examined the role of resilience factors (self-esteem, secure attachment, and p... more ABSTRACT The study examined the role of resilience factors (self-esteem, secure attachment, and perceived peer support) in predicting mental health symptoms and engagement in risk behaviors among 144 migrant adolescents of work migrants and asylum seekers compared to 146 native-born adolescents in Israel. Migrants’ age and gender were associated with mental health, higher engagement in risk behaviors among older participants, and elevated symptoms among females. Self-esteem, level of secure attachment, and supportive peer-relationships were correlated with lower mental health symptomatology amongmigrants. The findings highlight the importance of strengthening the interpersonal support systems of migrant youth for better mental health outcomes.
Immigration is not only about changing countries, but also about shifting identities. This change... more Immigration is not only about changing countries, but also about shifting identities. This change is especially important for adolescents. This article examines identity formation among 1.5 and 2 nd generation adolescent immigrants to Israel. A survey of 125 children of immigrants aged 12-19 examined the role of social structures such as pace of life, culture, religion and language on identity formation in 1.5 and 2 nd generational groups. We have identified several significant factors affecting the identities of children of migrants in each group. Looking beyond self-labeling, we argue that identity formation among children of immigrants is a continuous process in which the host country and origin country, both or neither of them, create dynamic hybrid patterns of identifications.
The study examined which socio-demographic differences between clients and providers influenced i... more The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity. A qualitative analysis investigated potential mechanisms that accounted for overall complementarity beyond match by examining client-provider dyads in the top and bottom quartiles of the complementarity measure. Results indicated significant interactions between client's race/ethnicity (Black) and provider's race/ethnicity (Latino) (p ϭ .036) and client's age and provider's age (p ϭ .044) on the Affiliation axis. The qualitative investigation revealed that client-provider interactions in the upper quartile of complementarity were characterized by consistent descriptions between the client and provider of concerns and expectations as well as depictions of what was important during the meeting. Results suggest that differences in social identities, although important, may be overcome by interpersonal variables early in the therapeutic relationship. Implications for both clinical practice and future research are discussed, as are factors relevant to working across cultures.
ABSTRACT We investigated the association between gender-role orientation and emotional distress a... more ABSTRACT We investigated the association between gender-role orientation and emotional distress among African male asylum-seekers in Israel. A convenience sample of 60 English-speaking asylum-seekers completed a measure of gender-roles, emotional distress, and posttraumatic stress (PTSD). Androgynous, feminine, and undifferentiated gender roles were most prevalent, while the presence of masculine gender-role was exceptionally low. Androgynous gender-role orientation, characterized by high levels of masculinity and femininity, was associated with lower emotional distress compared with feminine and undifferentiated gender-role orientations beyond the effects of sociodemographic variables and PTSD symptoms. Both instrumental and expressive traits may promote adaptive psychological functioning among African asylum-seeking men.
Purpose Improving the assessment of and access to appropriate care for mental health problems amo... more Purpose Improving the assessment of and access to appropriate care for mental health problems among persons with cancer is essential, particularly for population groups that are at high risk for psychopathology. This study characterized ethnic differentials regarding needs and service utilization by Jewish (n01,430) and Arab-Israeli (n0141) persons with cancer. Methods We reviewed 284 randomly selected active medical charts in an oncology clinic in a large public hospital (November 2010-April 2011). Results While 12 % of the charts of the Jewish-Israeli sample included a record of psychiatric disorders or symptoms, only 5 % of the charts of the Arab-Israeli sample had a similar record (χ²04.4, p<.05). Similarly, in a higher percentage of the charts of the Jewish-Israeli sample, the current utilization of psychotropics (18.2 and 5.6 %, respectively; χ²06.7; p<.01) and/or psychotherapy (7.8 and 1.4 %, respectively; χ²03.6; p<.05) was noted compared with the Arab-Israeli sample. Also, in a higher percentage of the charts of the Jewish-Israeli patients, a referral for psychotherapy was recorded compared with their Arab counterparts (9.1 and 4.3 % respectively; χ²06.3; p<.05). In contrast, 19.
Jewish-Israelis of European origin with cancer have higher suicide rates relative to their counte... more Jewish-Israelis of European origin with cancer have higher suicide rates relative to their counterparts in the general population. We investigated whether this effect results from the high proportion of Holocaust survivors among them, due to vulnerabilities arising from the earlier traumas they sustained. The study was based on all Jewish-European persons with cancer, 60 years and over, diagnosed in Israel between 1999 and 2007. The standardized incidence ratios were not significantly different between the exposed and nonexposed groups (men: 0.90, 95% CI 0.60-1.19; women: 0.95, 95% CI 0.55-1.37). Past exposure to maximum adversity did not increase the suicide risk among persons with cancer.
Objective: We investigated the association between socio-demographic and clinical variables with ... more Objective: We investigated the association between socio-demographic and clinical variables with mental health care stigma, and the impact of the latter on the quality of the therapeutic alliance measured at intake. Method: Consecutive clients (N = 236) filled questionnaires upon accessing services for a new episode of care. Immediately following the intake, a randomly selected sample of clients and their corresponding therapists (n = 102) completed the Working Alliance Inventory -Bond Scale. Results: Lower mean years of education and higher emotional distress (both partial r = .17) were significantly associated with higher stigma. Higher care stigma negatively correlated with therapists' ratings of the therapeutic alliance during the intake (partial r = −.22), but not with those of clients. Conclusions: Care stigma is present among service-users and may affect outcomes of the intake.
We investigated the association between the content of the information exchanged between clients ... more We investigated the association between the content of the information exchanged between clients and therapists during mental health intake and the quality of the therapeutic alliance. Thirty-eight therapists and 107 clients from four mental health clinics in Israel participated in the study. The content of information discussed was coded directly from the recorded intakes by blinded raters. Clients and therapists completed the Working Alliance Inventory immediately following the intake. Therapists spent the majority of intake time in collecting information about their clients' diagnostic symptoms and personal history and sociocultural background. Due to the high negative correlation between these factors, r(107) = -.68, p < .001, we created a measure of delta score with higher scores reflecting more discussion of personal history and sociocultural background and less discussion of diagnostic symptoms. We computed three-level hierarchical linear model analysis, with intakes n...
proposes the implementation of primary prevention strategies to reduce the mental health burden o... more proposes the implementation of primary prevention strategies to reduce the mental health burden of disease. The extent to which Israeli academic programs and published research adhere to the principles spelled out by the CMHAP is unknown.
Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and prac... more Adaptive functioning is a key aspect of psychiatric diagnosis and assessment in research and practice. This study compared adaptive functioning validity ratings from Structured Clinical Interviews (SCIDs, symptom-focused structured diagnostic interviews), and Clinical Diagnostic Interviews (CDIs, systematic diagnostic interviews modeling naturalistic clinical interactions focusing on relational narratives). Two hundred forty-five patients (interviewed by two independent interviewers) and their interviewers completed the Clinical Data Form which assesses adaptive functioning and clinical information. Both interviews converged strongly with patient-reports, with no significant differences in validity of the interviews in measuring global and specific domains of adaptive functioning variables. Findings suggest that CDIs provide adaptive functioning data comparable to SCIDs (often considered &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;gold standard&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; for assessment but difficult to use in practice) and have important implications for bridging the research-practice gap. By incorporating clinicians&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; everyday methods, CDIs yield information that is psychometrically sound for empirical investigation, diagnostically practical, and clinically meaningful and valid.
The Israel journal of psychiatry and related sciences, 2014
Community-based studies have documented gender differences in mental health problems and service ... more Community-based studies have documented gender differences in mental health problems and service utilization. This mixed methods study explored gender differences in severity of emotional distress, referral paths, presenting problems and care expectations among service users upon accessing outpatient psychiatric care. Consecutive service users (N=284, 64% women) who presented for a new or repeated episode of care in adult outpatient clinics completed questionnaires on a measure of emotional distress, treatment history and referral path. These variables were quantitatively analyzed. Also, users completed two open-ended questionnaires on reasons for seeking care and expectations from the services. These variables were qualitatively analyzed using thematic analyses. No significant gender differences emerged on any of the variables examined among new and repeated users. The main reasons for seeking care were psychiatric symptoms as well as non-specific psychopathology. The most frequent...
Cultural diversity & ethnic minority psychology, Jan 4, 2014
Past research has documented the role acculturation plays in the process of adjustment to new cul... more Past research has documented the role acculturation plays in the process of adjustment to new cultures among migrants. Yet little attention has been paid thus far to the role of acculturation in the context of forced migration. In this study we examined the association between acculturation patterns and mental health symptoms among a convenience sample of Eritrean and Sudanese asylum seekers (n = 118) who accessed health services at the Physicians for Human Rights Open-Clinic in Israel. Participants completed measures on sociodemographic information as well as detention history, mental health symptoms, exposure to traumatic events, and acculturation pattern, in their native language upon accessing services. Consistent with our predictions, findings showed that acculturation predicted depressive symptoms among asylum seekers beyond the effect of history of detention and reports of experiences of traumatic events. Assimilated compared with integrated asylum seekers reported higher dep...
The Israel journal of psychiatry and related sciences, 2012
Mental health disparities are differences in health status, risks and care favoring members of ad... more Mental health disparities are differences in health status, risks and care favoring members of advantaged over disadvantaged social groups. the contrasting social identities of clinicians and service-users may account for potential disparities found in clinical encounters, reflected, for example, in the provision of substandard care. the imputed mechanisms, however, remain unknown. Drawing on social psychological research we delineate a model to assist in identifying those mechanisms. we review the literature on processes rooted in social categorization (outgroup bias) and in social power (impaired perspective taking, making automatic attributions) and suggest that the contrasting social identities of clinicians and service-users can partially account for why discordant, compared to concordant ethnic identities in clinical encounters may produce worse outcomes, measured by the quality of the working alliance and the accuracy of diagnostic decisions. we provide preliminary evidence f...
ABSTRACT The study examined the role of resilience factors (self-esteem, secure attachment, and p... more ABSTRACT The study examined the role of resilience factors (self-esteem, secure attachment, and perceived peer support) in predicting mental health symptoms and engagement in risk behaviors among 144 migrant adolescents of work migrants and asylum seekers compared to 146 native-born adolescents in Israel. Migrants’ age and gender were associated with mental health, higher engagement in risk behaviors among older participants, and elevated symptoms among females. Self-esteem, level of secure attachment, and supportive peer-relationships were correlated with lower mental health symptomatology amongmigrants. The findings highlight the importance of strengthening the interpersonal support systems of migrant youth for better mental health outcomes.
Immigration is not only about changing countries, but also about shifting identities. This change... more Immigration is not only about changing countries, but also about shifting identities. This change is especially important for adolescents. This article examines identity formation among 1.5 and 2 nd generation adolescent immigrants to Israel. A survey of 125 children of immigrants aged 12-19 examined the role of social structures such as pace of life, culture, religion and language on identity formation in 1.5 and 2 nd generational groups. We have identified several significant factors affecting the identities of children of migrants in each group. Looking beyond self-labeling, we argue that identity formation among children of immigrants is a continuous process in which the host country and origin country, both or neither of them, create dynamic hybrid patterns of identifications.
The study examined which socio-demographic differences between clients and providers influenced i... more The study examined which socio-demographic differences between clients and providers influenced interpersonal complementarity during an initial intake session; that is, behaviors that facilitate harmonious interactions between client and provider. Complementarity was assessed using blinded ratings of 114 videotaped intake sessions by trained observers. Hierarchical linear models were used to examine how match between client and provider in race/ethnicity, sex, and age were associated with levels of complementarity. A qualitative analysis investigated potential mechanisms that accounted for overall complementarity beyond match by examining client-provider dyads in the top and bottom quartiles of the complementarity measure. Results indicated significant interactions between client's race/ethnicity (Black) and provider's race/ethnicity (Latino) (p ϭ .036) and client's age and provider's age (p ϭ .044) on the Affiliation axis. The qualitative investigation revealed that client-provider interactions in the upper quartile of complementarity were characterized by consistent descriptions between the client and provider of concerns and expectations as well as depictions of what was important during the meeting. Results suggest that differences in social identities, although important, may be overcome by interpersonal variables early in the therapeutic relationship. Implications for both clinical practice and future research are discussed, as are factors relevant to working across cultures.
ABSTRACT We investigated the association between gender-role orientation and emotional distress a... more ABSTRACT We investigated the association between gender-role orientation and emotional distress among African male asylum-seekers in Israel. A convenience sample of 60 English-speaking asylum-seekers completed a measure of gender-roles, emotional distress, and posttraumatic stress (PTSD). Androgynous, feminine, and undifferentiated gender roles were most prevalent, while the presence of masculine gender-role was exceptionally low. Androgynous gender-role orientation, characterized by high levels of masculinity and femininity, was associated with lower emotional distress compared with feminine and undifferentiated gender-role orientations beyond the effects of sociodemographic variables and PTSD symptoms. Both instrumental and expressive traits may promote adaptive psychological functioning among African asylum-seeking men.
Purpose Improving the assessment of and access to appropriate care for mental health problems amo... more Purpose Improving the assessment of and access to appropriate care for mental health problems among persons with cancer is essential, particularly for population groups that are at high risk for psychopathology. This study characterized ethnic differentials regarding needs and service utilization by Jewish (n01,430) and Arab-Israeli (n0141) persons with cancer. Methods We reviewed 284 randomly selected active medical charts in an oncology clinic in a large public hospital (November 2010-April 2011). Results While 12 % of the charts of the Jewish-Israeli sample included a record of psychiatric disorders or symptoms, only 5 % of the charts of the Arab-Israeli sample had a similar record (χ²04.4, p<.05). Similarly, in a higher percentage of the charts of the Jewish-Israeli sample, the current utilization of psychotropics (18.2 and 5.6 %, respectively; χ²06.7; p<.01) and/or psychotherapy (7.8 and 1.4 %, respectively; χ²03.6; p<.05) was noted compared with the Arab-Israeli sample. Also, in a higher percentage of the charts of the Jewish-Israeli patients, a referral for psychotherapy was recorded compared with their Arab counterparts (9.1 and 4.3 % respectively; χ²06.3; p<.05). In contrast, 19.
Jewish-Israelis of European origin with cancer have higher suicide rates relative to their counte... more Jewish-Israelis of European origin with cancer have higher suicide rates relative to their counterparts in the general population. We investigated whether this effect results from the high proportion of Holocaust survivors among them, due to vulnerabilities arising from the earlier traumas they sustained. The study was based on all Jewish-European persons with cancer, 60 years and over, diagnosed in Israel between 1999 and 2007. The standardized incidence ratios were not significantly different between the exposed and nonexposed groups (men: 0.90, 95% CI 0.60-1.19; women: 0.95, 95% CI 0.55-1.37). Past exposure to maximum adversity did not increase the suicide risk among persons with cancer.
Objective: We investigated the association between socio-demographic and clinical variables with ... more Objective: We investigated the association between socio-demographic and clinical variables with mental health care stigma, and the impact of the latter on the quality of the therapeutic alliance measured at intake. Method: Consecutive clients (N = 236) filled questionnaires upon accessing services for a new episode of care. Immediately following the intake, a randomly selected sample of clients and their corresponding therapists (n = 102) completed the Working Alliance Inventory -Bond Scale. Results: Lower mean years of education and higher emotional distress (both partial r = .17) were significantly associated with higher stigma. Higher care stigma negatively correlated with therapists' ratings of the therapeutic alliance during the intake (partial r = −.22), but not with those of clients. Conclusions: Care stigma is present among service-users and may affect outcomes of the intake.
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Papers by Ora Nakash